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Understanding the Anatomy of the Axilla

Explore the detailed boundaries, walls, contents, and structures of the axilla. Learn about nerve supply, injuries, lymphatic drainage, and associated anatomical features in this comprehensive guide.

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Understanding the Anatomy of the Axilla

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  1. AXILLA • It is a fat filled pyramidal space between the lateral thoracic wall and the upper arm. • Nerves, blood vessels and lymphatics pass from the root of the neck to the axilla through the cervico-axillary canal.

  2. BOUNDARIES • The axilla has : • 1. Apex : it isbounded by: • In front : clavicle. • Behind : upper border of the scapula. • Medially : outer border of the first rib.

  3. BOUNDARIES • 2. Base (lower end) • It is formed by the hairy axillary skin. • Its boundaries are: • In front :anterior axillary fold. • Behind :posterior axillary fold. • Medially:chest wall.

  4. WALLS • The axilla has the following walls : • Anterior. • Posterior. • Medial. • Lateral. • The base is stretched between the anterior and posterior walls.

  5. ANTERIOR WALL • Is formed by : • 1. Pectoralismajor. • 2. Pectoralisminor. • 3. Subclavius & • Clavipectoral fascia.

  6. POSTERIOR WALL • Formed by : • 1. Subscapularis. • 2. Latissmus dorsi. • 3. Teres major.

  7. MEDIAL WALL • It is formed by : • 1.Upper (4) ribs. • 2.Intercostalmuscles. • 3.Serratus anterior.

  8. SERRATUS ANTERIOR • Origin : • Outer surface of the upper (1-8) ribs. • Insertion : • Medial border of the scapula (especially the inferior angle).

  9. SERRATUS ANTERIOR • Nerve supply : • Long thoracic nerve. • Action : • 1.Holds the scapula against the thoracic wall. • 2. protraction of the scapula. • 3. Rotation of thescapula (inferior angle).

  10. WINGED SCAPULA • Injury to the long thoracic nerve (in radical mastectomy) causes paralysis of serratus anterior. • The medial border and inferior angle of the scapula will no longer be kept closely applied to the chest wall.

  11. WINGED SCAPULA • It will protrudeposteriorly. • The patient has difficulty in raising the arm above the head(difficult in rotation of the scapula).

  12. LATERAL WALL • It is narrow. • It is formed by : • 1. Bicipitalgroove of the humerus. • 2. Biceps. • 3. Coracobrachialis.

  13. CONTENTS • 1. Axillary artery. • 2. Axillary vein. • 3. Cords of brachial plexus. • 4. Axillary lymphnodes. • 5. Fat. • 6. Axillary sheath.

  14. AXILLARY ARTERY • Beginning : • At the outer border of the 1st rib as a continuation of thesubclavian artery. • Termination : • Lower border ofteres majorby becoming the brachial artery.

  15. AXILLARY ARTERY • Course : • It is divided bypectoralis minorinto three parts.

  16. RELATIONS • The artery is enclosed throughout its course with the brachial plexus and the axillary vein with a sheath of deepfascia (Axillary sheath).

  17. 1ST PART • It extends from the beginning of the artery to the upper border of pectoralis minor. • Anterior :skin, fascia and pectoralis major. • Posterior : long thoracic nerve.

  18. 1ST PART • Medial :axillary vein. • Lateral :three cords of the brachial plexus.

  19. 2ND PART • It is behind pectoralis minor. • Anterior :skin, fascia, pectoralis minor and major. • Posterior :posterior cord of the brachial plexus, subscapularis.

  20. 2ND PART • Medial :medial cord of the B.P. and axillary vein. • Lateral :lateral cord of the B.P.

  21. 3RD PART • It begins at the lower border of pectoralisminor and ends at the lower border of teres major by becoming the brachial artery. • Anterior :pectoralis major, medial root of median nerve.

  22. 3RD PART • Posterior: • Muscles:subscapularis, teres major & latissmusdorsi. • Nerves:axillary and radial.

  23. 3RD PART • Lateral : • Nerves musculocutaneous. • lateral root of median nerve. • Muscles : biceps and coracobrachialis.

  24. 3RD PART • Medial:Axillary vein. • Nerves :ulnar and medial cutaneous nerve of the arm.

  25. BRANCHES • First part : superior (highest) thoracic. • Second part : • A. Thoracoacromial. • B. Lateral thoracic.

  26. BRANCHES (3RD PART) • 1.Anterior circumflexhumeral. • 2.Posterior circumflexboth anastomosearound the surgical neck of the humerus). • 3. Subscapular : gives circumflex scapular(share in the anastomosis around the scapula)

  27. AXILLARY VEIN • Formation : • Basilic vein + venae comitantes of the brachial artery. • Beginning : • Lower border of teres major. • Course : • It runs along the medial side of the axillary artery.

  28. AXILLARY VEIN • Course : • It runs along the medial side of the axillary artery. • Trmination : • At outer border of the 1st rib. • It becomes thesubclavian vein.

  29. AXILLARY LYMPH NODES • They are (6) groups. • They drain : • 1. Lateral quadrants of the breast. • 2. Thoracoabdominal walls above umbilicus. • 3. Upper limb.

  30. AXILLARY LYMPH NODES • 1. Pectoral (Anterior) • Lie behind pectoralis major, along lower border of pectoralis minor. • It receives lymph from: • 1.Lateral quadrants of the breast. • 2.Abdominal wall above umbilicus.

  31. AXILLARY LYMPH NODES • 2. Subscapular (Posterior) • Lie in front of subscapularis. • Receives lymph of the back down to the iliac crest. • 3. Lateral : • Lie along medial side of the axillary vein. • Receives from the upper limb except its lateral side.

  32. AXILLARY LYMPH NODES • 4. Central : • Lie in the axillary fat. • Receives from the above three groups. • 5.Infraclavicular (deltopectoral): • Lie in the groove between pectoralis major and deltoid (outside axilla).

  33. AXILLARY LYMPH NODES • 5.Infraclavicular (deltopectoral): • Receives fromlateral sideof: • Arm, forearm and hand.

  34. AXILLARY LYMPH NODES • 6. Apical : • Lie at the apex of the axilla , at the lateral border of the 1st rib. • It receives efferent vessels from all the other lymph nodes. • They drain into the Subclavianlymph trunk.

  35. DRAINAGE • On right side : • The trunk drains into rightlymph trunk. • On left side : • It drains into thoracic duct.

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